Revista de Farmacologia Clínica e Experimental

Abstrato

Fulminant Hepatitis Managed with Pentoxifylline

Jiménez-Luévano MA, Ramírez-Flores S, Sepúlveda-Castro R, Jiménez-Partida AE, Jiménez-Partida MÁ, Ruiz-Mercado H, Cortés-Aguilar Y, Bravo-Cuellar A, Hernández-Flores G

Introduction: Fulminant hepatitis is a severe clinical entity that has a prevalence of 10/1,000,000, and its mortality can reach 80% of registered cases. Its etiology is multifactorial and does not respect gender, age, or socioeconomic or cultural levels. Transcription factor NF-κB, oxidative stress, proinflammatory cytokines such as TNF-α, IL-1β, and IL-6 and growth factors play a fundamental role in this pathology. Treatment-of-choice is liver transplantation; however, the latter is far from being the ideal solution due to its accessibility and cost. Thus, we use the Pentoxifylline inhibitor of NF-κB and inflammatory and oxidative processes.

Objective: To assess the response of patients with fulminant hepatitis using pentoxifylline.

Methods: The four pediatric cases, diagnosed and classified with fulminant hepatitis, presenting all indicators of poor prognosis according to the criteria of British Kings College. These patients received treatment with Pentoxifylline 200 mg every 12 h i.v. All patients received the following support treatment: fresh plasma; vitamin K; anti-ammonium measures; anti-cerebral edema (Mannitol); antimicrobials; ventilatory support; parenteral solutions, as well as parenteral and enteral nutrition (when they tolerated administration via the oral route).

Results: Presenting a favourable response to the on-average 2 weeks of treatment initiation, in relation to neurological, cognitive, and hemodynamic damage, with clinical and laboratory improvement, evaluating the patients discharged without presenting complications between days 8-10 days after leaving the Intensive Care Unit (ICU).

Conclusion: The results confirm previous observations and are encouraging for multicenter and randomized studies.